Gynaecological Laparoscopy (Keyhole Surgery): Indications and Recovery

Laparoscopy, commonly described as keyhole surgery, is performed through several 5–10 mm incisions in the abdominal wall using a camera and fine instruments. The abdominal cavity is inflated with carbon dioxide so that the pelvic organs can be seen clearly, and the operation is carried out under high-definition monitor guidance. The majority of gynaecological operations can now be completed in this way.

Which conditions are treated?

• Ovarian cysts: cystectomy, or removal of the ovary where necessary.
• Endometriosis and endometriomas: excision of deposits, division of adhesions and relief of pain.
• Fibroids: uterus-sparing removal (myomectomy).
• Ectopic pregnancy and ovarian torsion: emergency, organ-preserving surgery.
• Fertility assessment: confirmation of tubal patency by dye test and treatment of pelvic adhesions.
• Chronic pelvic pain: diagnostic laparoscopy where imaging has not provided an explanation.
• Hysterectomy and selected gynaecological oncology procedures.

Preparation for surgery

• Full blood count, biochemistry and clotting studies, with an ECG and chest radiograph where indicated.
• Ultrasound, and MRI where the lesion requires more detailed assessment.
• Fasting for six to eight hours before the operation.
• Adjustment of anticoagulant medication under medical supervision; stopping smoking at least two weeks beforehand improves healing.

How the procedure is performed

Surgery is carried out under general anaesthesia. Access is obtained at the umbilicus, the abdomen is insufflated and the camera is introduced. One to three additional incisions in the lower abdomen accommodate the instruments. At the end of the procedure the gas is released and the incisions are closed with fine sutures. Diagnostic procedures take 20–40 minutes; advanced surgery takes 1.5 to 3 hours.

Advantages over open surgery

• Less blood loss and a lower rate of wound infection.
• Less postoperative pain and a reduced requirement for analgesia.
• A short hospital stay, with same-day or next-day discharge in most cases.
• Fewer intra-abdominal adhesions and smaller scars.
• A considerably faster return to normal activity and work.

Risks and complications

Serious complications occur in fewer than 1% of cases. Injury to blood vessels, bowel, bladder or ureter, bleeding, infection, port-site hernia and anaesthetic complications are all uncommon. Where there are extensive adhesions, very large masses or a high body mass index, the operation may be converted to open surgery. Conversion is not a failure but a decision that places patient safety first.

Recovery

• Shoulder and back discomfort in the first 24–48 hours is caused by residual gas and settles quickly with walking.
• The incisions heal within 7–10 days, and showering with a waterproof dressing is usually permitted.
• Return to desk work takes 5–10 days; heavy work and sport are resumed after three to four weeks.
• Fever, increasing abdominal pain, discharge from an incision, leg swelling or breathlessness require prompt medical review.

Op. Dr. Sadık Kükrer, MD provides gynaecological laparoscopy, endometriosis and fibroid surgery in Adana, Türkiye.